Aural microsuction: an analysis of post-procedure patient safety incidents.

BACKGROUND: Aural microsuction can be associated with delayed syncopal and vertiginous events, which can lead to serious adverse patient safety incidents. OBJECTIVE: This article highlights the serious risks associated with microsuction. MATERIALS AND METHODS: We performed a retrospective review of the hospital risk database over a 2-year period. RESULTS: Three patients experienced severe adverse events post microsuction. Two patients fell down the stairs after microsuction, with one suffering a lower limb fracture. One patient experienced loss of consciousness and subsequent head trauma post microsuction. CONCLUSIONS AND SIGNIFICANCE: Whilst aural microsuction is universally accepted to be a low-risk procedure, subsequent serious morbidity can occur. Implementation and awareness of local safety policies are imperative to avoid post-procedure injury.

Cystic hygroma in adults: a single-centre experience and review of the literature.

Cystic hygroma (CH) is a benign congenital lymphatic malformation, occurring predominantly in children, typically as an asymptomatic neck mass. Surgical resection or sclerotherapy is the recommended treatment options. A retrospective review of four cases of adult-onset CH was performed over 2 years by a single surgeon across two institutions. Four patients (two females, median age 31.5 years) who presented with supraclavicular neck masses (range 5-17 cm) are discussed. Ultrasound and MRI demonstrated supraclavicular masses, suggestive of CH. All patients underwent surgical resection. Post-operative courses were uncomplicated, with a mean length of stay of 4 days. All histological samples returned as CH. As of yet, there are no guidelines on the management of CH. Individualised care tailored to each patient, following careful discussion is the most prudent approach. This study demonstrates that surgical resection is a safe and effective treatment for adults in this rarely encountered clinical entity.

Cadaveric evaluation of sternal reconstruction using the pectoralis muscle flap.

BACKGROUND: Deep sternal wound infection is a significant complication of open cardiac surgery associated with increased mortality and morbidity. The use of muscle flaps, such as the pectoralis major advancement flap, in deep sternal wound infection reconstruction reduces hospital stay and mortality. However, the lower end of the sternum is remote from the vascular supply and cover is therefore problematic in many cases. METHODS: This study aimed to determine the distance (cm) and surface area (cm2 ) of sternum covered when the pectoralis major muscle is sequentially dissected from the sternocostal origin and humeral insertion using 10 cadaveric specimens. RESULTS: The largest proportion of sternum was covered when both the origin and insertion were divided, allowing the flap to be islanded on its vascular pedicle. There was a statistically significant difference when the pectoralis major was divided from the origin and insertion compared to division of the origin alone (P < 0.01). The average area covered with sternocostal origin division alone was 55.43 cm2 compared to 85.36 cm2 after division of both the origin and insertion. CONCLUSION: Division of both the sternocostal origin and humeral insertion of the pectoralis major muscle represents an effective means to increase sternal coverage. This study describes the average distance and area covered by sliding pectoralis major muscle advancement flaps. These measurements could better inform plastic surgeons when evaluating reconstructive options in sternal defects.